- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,370.32 / $12,882.50
| Facility | | $977.24 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $741.31 / $954.99
| Professional | | $616.60 | $741.31 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $977.24 / $1,202.26
| Professional | | $851.14 | $977.24 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,513.56
| Facility | | $660.69 | $912.01 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $954.99 / $8,709.64
| Facility | | $588.84 | $954.99 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,244.36 / $14,125.38
| Facility | | $3,890.45 | $7,244.36 | $14,125.38 |